Provider Demographics
NPI:1255368577
Name:COLLINS, MICHELLE KAREN (PH D)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:KAREN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LOGGER CT
Mailing Address - Street 2:SUITE 103G
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8525
Mailing Address - Country:US
Mailing Address - Phone:888-983-7771
Mailing Address - Fax:
Practice Address - Street 1:1100 LOGGER CT
Practice Address - Street 2:SUITE 103G
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:888-983-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33009103T00000X
NC3438103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist